(R)evolutionary Medicine: How Darwinian Medicine Could Transform Our Health-Care System

The health of Homo sapiens is failing. Chronic diseases and health problems such as acne vulgaris, cancer, myopia, and heart disease are today so common that they are by some considered to be a natural part of human life. Only a select few live long lives, free of disease. These healthy individuals are often referred to as lucky, as if the primary reason they don’t get sick is that they are favored by God or the universe, or have inherited a unique set of genes that protect them from disease. Sometimes, food, heritage, and lifestyle are also pulled into the equation. We ask healthy centenarians about what they’ve eaten throughout their life, how much sleep they’ve gotten, and what kinds of exercises they’ve been doing, in an attempt to discover the secrets to healthy living.

If you collect a group of healthy, long-lived people and ask each of them these types of questions, the answers you’ll get will probably vary widely. Some may tell you that a high intake of vegetables is what protected them from disease, others may say that regular exercise is the key to a healthy life, and yet others may say that x food – be it a soup, drink, or some type of solid substance – equipped them with a solid immune system and healthy cardiovascular system. Yet others again may attribute their healthy ageing to divine intervention, saying that their belief in God or some other all-powerful force was what made them stay clear of illness and live as long as they have. In other words, they all seem to have different explanations for why they, unlike many of their peers, aren’t wasting away in a hospital bed.

Based on the answers of these long-lived folks, it seems like there is no clear pattern as to which behaviors and activities that promote health and vitality. There doesn’t seem to be any system, there is only confusion, anecdotes, and disorder. This also seems to be the case for the rest of our medical system. Different doctors, nutritionists, and health/nutrition scientists often have widely different opinions about health and disease: how disease should be treated, what kind of medicines that should be used, and why illness arises in the first place.

There is no conceptual framework in place that underlies medicine and guides and supports clinicians and scientists in their quest for knowledge. This is unfortunate, because without a solid foundation to rest on, the health-care system is prone to get weak in the knees, develop disease, and perhaps even collapse completely.

Healing a sick system

Some people, myself included, would argue that our current health-care system is sick – it’s not working as well as it should or could. Over the past centuries, great strides have been made with regards to the treatment of injuries and wounds, and doctors have learned how to perform surgical procedures in a safer and more effective manner. We’ve also been able to thwart the spread of many infectious diseases via mass-vaccination and interventions aimed at improving public sanitation and hygiene.

However, in other areas, things haven’t been going so well. Modern medicine hasn’t been able to stop the spread of chronic diseases and health problems such as colon cancer, heart disease, obesity, the metabolic syndrome, and autism. These and many, many other health problems have increased dramatically in prevalence lately – not just in the developed world, but also in many developing countries. Not only that, but people’s general health status is on the decline. Virtually nobody is truly healthy anymore; we all seem to be suffering from some type of health problem, whether it’s irritable bowel syndrome, low libido, skin rashes, chronic fatigue, or frequent headaches.

Health exists on a spectrum, ranging from excellent health on the left, to chronic disease and death on the right. Most contemporary humans are probably closer to the right than the left end, a statement supported by evidence showing that hunter-gatherers and other traditional people who live in a milieu that resembles the ones our genus Homo evolved in over millions of years are markedly healthier than those of us who grow up and live in a modern, built environment (1, 2, 3). They set a new standard as to what is normal for our species.

The reference ranges doctors use when they measure and interpret their patients’ blood pressure, cholesterol, iron status, and so forth are not based on what’s the evolutionary norm for our species, rather, they are based on what is normal today. Unfortunately though, what is normal today is typically very different from what was normal in the past. Today, it’s normal to be overweight – more than 50% of people in the U.S. and many other countries are; it’s normal to get acne – virtually all of us do sometime during our life; and it’s normal to never feel fully healthy, experiencing mild colds, gastrointestinal distress, and fatigue on a regular basis.

This begs the question: Should we really strive to be normal? … Isn’t it better to strive to be healthy? If so, then we have to change our approach to medicine. Instead of looking at the world as a picture, we have to start looking at it as a movie; a film that has already been rolling for a very long time.

Seeing the world as a movie, not as a picture

Let’s imagine that you go to the theater to see a movie, but arrive way too late. You don’t know anything about what has happened in the movie prior to the time you show up; hence, you don’t fully understand what’s happening on the screen; why the characters behave the way they do, how all the players ended up at the current scene of action, and how the interactions of the past have shaped what goes on in the present.

How can you collect and assimilate the information you need to understand what’s going on? The movie is already rolling, and you’re in the theater. In other words, it’s too late to go back and watch it from the start. That leaves you with two possible options: 1) You can watch the movie and try to understand, by following what’s going on in the present, what took place earlier in the film, or 2) You can try to collect the information in other ways, for example by asking the guy or girl next to you in the movie theater what’s happened earlier in the film; checking the film magazine you grabbed on the way into the theatre to see if there’s anything written about the film; or searching your phone for information about the movie.

By itself, option number 1 will likely not give you a good picture of what’s been going on earlier in the film; you have to combine it with one or more of the strategies under option 2 to really make some headway. You have to collect as much credible information about what’s happened in the past as you can find, and then use that information to understand what’s happening in the present. Only then can you understand why the current scene of the movie is like it is.

I would argue that this is how we should approach health and disease. If we don’t know or understand what’s happened in the past, we’ll never know or understand why things are like they are in the present: why the human body looks and functions as it does, why some diseases have increased dramatically in prevalence over the past decades, how cancer develops, what we can and should do to reverse the obesity epidemic, and how we can improve our health care-system.

The Evolutionary Health Model: A powerful tool every doctor should possess

Mainstream medicine largely treats symptoms, not disease. It hasn’t done a good job of preventing or curing chronic diseases or addressing the root causes of illness, it typically only suppresses the fire that is bound to fully ignite at some time or another. Sometimes, its treatments may even fuel the fire, thereby aggravating disease processes over the long-term.

I would argue that incorporating evolutionary theory into medical training and clinical medical practice could go a long way towards changing all of this. A rapidly growing number of scientists hold a similar belief. Over the past couple of decades, a long list of studies and review papers on Darwinian medicine has been published (e.g., 4, 5, 6, 7, 8). There is a general consensus among the authors of these articles that it’s long past time that evolutionary health principles are incorporated into our medical system.

Here’s a quote that nicely summarizes this consensual belief:

We argue that the future of medical research and practice will increasingly require an evolutionary perspective to address the new health concerns of the 21st century. These will include chronic disease, mental health, as well as other issues such as emerging pathogens. The ability of physicians and biomedical researchers to link ultimate evolutionary explanations for disease to their proximate mechanisms shall become increasingly important. Therefore the sooner we revise medical preparation to integrate evolutionary perspectives, the better primed we will be to address the medical challenges of the 21st century. (8)

A conceptual model designed on the basis of evolutionary/biological sciences would help guide scientists and clinicians in their work, equipping them with invaluable information and tools. The evolutionary discordance model would be an essential part of this foundational structure and would help inform physicians about the origins, etiology, and prevention of various diseases, in particular the ones that develop as a result of evolutionary mismatches.

The Evolutionary Health Model is powerful; however, it doesn’t provide quick fixes. A lot of people are unwilling to put in an effort to be healthy. They don’t go to their doctor because they want advice on how to eat better or sleep more, but rather because they want a quick fix to their problems – a pill or drug that can make them better fast. These people, at least the ones who are completely resistant to change their behavior, will have to make do with the drug-centric approach that dominates medicine today. This solution will never make them healthy, but at least it will keep some of their symptoms at bay.

It’s the people who are willing to put in a little effort to be healthy that will likely benefit the most from widespread incorporation of evolutionary health concepts into clinical medical practice. These motivated patients may find a lot of answers, solutions, and comfort in Darwinian medicine. By combining the best from both Darwinian and mainstream medicine, they may be able to dramatically improve their health status and outlook on life.

Last words

Our modern environment is very different from the ones our primal forebears occupied. Whereas some things have changed for the better, other things have changed for the worse. Today, we’re constantly breathing in pollutants, processed food is everywhere, rivers, lakes, trees, and singing birds are all but missing from our proximate environment, and we’re constantly exposed to artificial lighting. There are many of these things we can do something about; however, there are also some that we have virtually no control over. Unless we take the drastic step of moving into the wilderness, we will breathe in air-borne pollutants on a regular basis and be exposed to a lot of other stuff that can do us harm. In other words, we’ll never be able to achieve pristine conditions of life.

That’s fine. After all, the goal isn’t to lead a strict, perfect life or be miserable in order to be healthy. The goal, I would argue, is to find a balance between doing what is optimal in terms of health/fitness and what is enjoyable/pleasurable. To some people, these things may seem completely unrelated. They associate health/fitness with strenuous work, effort, sweat, and tears – a perception that may have been imprinted in their minds via TV shows such as the Biggest Loser, which displays fitness as a struggle that involves lots of tears and puking. My experience, though, is that the things that bring about better health are typically also the same things that bring happiness, pleasure, and fulfillment!

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